The applicant; Udo Hoffmann MD MPH is a clinically active staff radiologist in the Division of Cardiac Imaging at Massachusetts General Hospital and an Associate Professor of Radiology at Harvard Medical School. Over the last 10 years Dr. Hoffmann's research has focused on the feasibility, accuracy, and clinical utility of advanced cardiovascular imaging, specifically the role of cardiac CT in ischemic heart disease. Dr. Hoffmann's prior mentoring experience, his publication and funding record together with his current and planned research support in Cardiovascular Imaging in Ischemic Heart Disease demonstrate his commitment and passion for Patient Oriented Research and provide an excellent foundation to accomplish the goals and objectives of the K24 Award. The specific aims addressing the purpose of the K24 Award are: 1) To enable Dr. Hoffmann to dedicate 25% of his time to mentor junior clinical investigators based on already NIH funded projects in Cardiovascular Imaging in Ischemic Heart Disease; 2) To mentor junior clinical investigators from the T-32 program and the pool of residents, fellows, and junior faculty in Cardiology and Radiology with the goal to develop them into clinical researchers who can successfully compete for peer reviewed grants; and 3) To enable Dr. Hoffmann to further establish a patient orientated research program that combines innovative translational, clinical, and outcomes research in cardiovascular imaging and that provides an ideal environment to develop future leaders in clinical research. Dr. Hoffmann's role as the Director of the Cardiac MR CT PET Program, a clinical research program in cardiovascular imaging supported by the Division of Cardiology and the Department of Radiology and Dr. Hoffmann's responsibilities as the Co-director of a T32 training grant in cardiovascular imaging, in addition to the strong commitment he received from the leadership of both Cardiology and Radiology provide an environment that is ideal to successfully mentor junior clinical investigators and fulfill the purpose of the K24 Award. The specific research aims of this grant stem from a significant body of work accomplished over the past few years and are all based on on-going NIH funded projects, except Aim 4 which is new research specifically supported by this grant: 1) Subclinical Cardiovascular Disease - Association with Risk factors and Clinical Outcomes in the Framingham Heart Study, 2) Comparing Competing Diagnostic Strategies to Triage Patients with Acute Chest Pain in the ED - A Randomized Diagnostic Multicenter Trial with the major goal to determine whether cardiac CT is more efficient in the management of patients with acute chest pain than standard of care, 3) Comparing Competing Diagnostic Strategies in the Patients with Stable Chest Pain - Diagnostic Efficiency of Cardiac CT vs. Standard of Care - The Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), and 4) Combining high sensitivity troponin, a new improved biomarker assay, with cardiac CT to determine the etiology of myocardial injury and improve the efficacy of detecting acute coronary syndrome due to coronary artery disease.